Efficacy of pegfilgrastim in preventing febrile neutropenia during DCF chemotherapy for esophageal cancer: A systematic review and meta-analysis.
Khaled Hemdan, Rana Mohamed El Tabakh, Ziad W Elmezayen et al.
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In 30 seconds
This systematic review and meta-analysis assessed prophylactic pegfilgrastim for preventing febrile neutropenia (FN) in patients with esophageal cancer receiving docetaxel, cisplatin, and fluorouracil (DCF) chemotherapy. It included retrospective and prospective studies comparing pegfilgrastim with placebo or no G-CSF. Pooled analysis found lower FN odds with pegfilgrastim (OR = 0.283, 95% CI: 0.102-0.782, p = 0.015). Pegfilgrastim was also associated with lower severe neutropenia rates and shorter hospital stays, without a significant increase in adverse events. The authors note that prospective randomised trials are needed.
Key findings
- Pegfilgrastim prophylaxis was associated with reduced FN incidence: OR = 0.283, 95% CI: 0.102-0.782, p = 0.015.
- FN rates ranged from 3.3% to 30.8% with pegfilgrastim versus 26.7% to 60.6% in control groups.
- Pegfilgrastim was associated with lower rates of severe neutropenia and shorter hospital stays.
- No significant increase in adverse events was reported.
Why it matters
FN is a serious complication of DCF chemotherapy and can contribute to treatment delays, hospitalisation, and morbidity. The pooled findings suggest pegfilgrastim prophylaxis may reduce this risk in patients with esophageal cancer receiving DCF, while also being associated with fewer severe neutropenia events and shorter hospital stays. These outcomes are clinically relevant, although the evidence base includes non-randomised studies.
What to keep in mind
The review included retrospective and prospective studies, and the authors call for prospective randomised trials to confirm benefits and optimise dosing strategies.